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Dementia, Alzheimer And Incontinence: Managing Bladder Control & Different Stages

In this article, we will learn about Dementia, Alzheimers, and Incontinence. We will learn about what stage of dementia is associated with incontinence and issues, managing symptoms, and improving patient care.

dementia-couple-taking-picture

Understanding Dementia, Alzheimer And Incontinence

It is important to understand dementia, Alzheimer’s, and incontinence as these conditions are linked together. Additionally, it has an impact on millions of people around the world.

Dementia is the decline in one’s cognitive function which involves judgment, problem-solving, memory, and language. This condition is progressive and affects one’s ability to navigate their daily tasks, such as communication and maintaining relationships.

Alzheimer’s disease accounts for the highest percentage of dementia cases and is a degenerative brain disorder that targets memory, behavior, and thinking. It is characterized by the buildup of the proteins beta-amyloid and tau, which disrupt normal brain function.

Incontinence or urinary incontinence (UI), is when one loses bladder control, which causes involuntary urine leakage. To add on, fecal incontinence (FI) is when one loses the ability to control their bowels, which results in the involuntary passage of stool. This is the most common symptom for patients with Alzheimer’s or dementia.

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What Is The Connection Between Dementia And Incontinence?

The connection between dementia and incontinence is that it affects people with Alzheimer’s and nursing home residents with dementia. It is always linked with the elderly, cognitive decline, and those with physical disabilities increasing. It affects the quality of life for dementia patients, including their caregivers, thus increasing the possibility of social isolation, depression, and anxiety.

Is Incontinence A Sign Of Dementia?

Both urinary and fecal incontinence are common symptoms that are linked with mid to late-stage dementia. Dementia is linked with incontinence due to declining cognitive function, medication, and environmental issues that prevent patients from reaching the washroom in time.

There are a few reasons that contribute to incontinence in people with dementia:
  • As dementia progresses, patients may not be able to control their bladder or bowel function because of memory issues and their attention span.
    Medications like sleeping pills relax the bowel muscles, leading to incontinence. Physical barriers such as narrow hallways make it an issue for dementia patients to reach the bathroom in time.
  • Other neurological conditions, like stroke or Parkinson’s disease, can affect movement, which causes incontinence.

What Stage Of Dementia Does Incontinence Come In?

Incontinence creeps in during the middle to late stages of dementia. It begins during the middle stages of dementia because that is when cognitive functions start to significantly decline, medication takes a stronger toll, and the environment starts to become a huge obstacle. In the late stages of dementia, there will be a significant loss of muscle control, an inability to convey their needs, and a dependence on caregivers. It is important to know that incontinence is not inevitable so it is best to work with healthcare professionals to come up with an effective management plan.

Identifying Incontinence In Early And Mid Stages Of Dementia

It is important to identify incontinence in the early and mid stages of dementia by noticing if there are changes in a patient’s behavior, such as being restless, verbal cues from the patient that indicate the need to use the washroom, physical signs like squirming, and changes in sleep patterns. It is also crucial that they go through sensory activities for dementia patients.

Incontinence can occur in dementia patients during the mid-to-late stages of the condition. However, it’s essential to recognize the early signs to manage the symptoms effectively. Some common signs that indicate the beginning of incontinence in dementia patients include:

Caregivers play an important role in monitoring and managing incontinence early on by getting the patients to come up with a regular routine for using the bathroom, using visual reminders to help the person remember, and encouraging communication. Make sure that the toilet is easily accessible and be patient and understanding when dealing with dementia patients.

Incontinence In Advanced Dementia

Here are some ways to manage incontinence in patients battling advanced dementia. You will need to create a supportive environment by allowing easy access to the washroom, installing non-slip mats or grab bars, coming up with a routine to help the patient develop a sense of routine, and using a toilet chart as a reminder. However, adult diapers need to be used to protect against accidents. Ensure that the dementia patient’s skin is always moisturized and encourage the patient to have as much autonomy over their own care as possible. Let them express themselves, and acknowledge their feelings and concerns about incontinence.

Here are practical tips for managing incontinence in late-stage dementia. Keep a toilet log and use visual reminders for the patient to know when to use the toilet. Use pleasant scents and music therapy for dementia to create a calm bathroom atmosphere and light therapy for dementia ensures that the patient is hydrated well to avoid urinary incontinence. Keep a spare set of clothes in case accidents may arise and always seek help from a healthcare professional to provide additional guidance and support.

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What Stage Of Dementia Does Incontinence Come In?

Bowel or fecal incontinence affects dementia patients in the middle to later stages. Memory loss impacts the patient’s ability to control their bowel movements. As their memory continues to regress, they may forget to use the toilet, struggle to remove their clothing, clean after using the toilet, and even leave the bathroom in a mess. Reduced mobility is another reason for toileting. This is because the patient is unable to move, has an issue sitting or standing for a long time, and requires assistance to clean themselves after using the washroom.

Does Dementia Affect Bladder Control?

Dementia affects bladder control, leading to incontinence. The neurological changes that lead to incontinence are due to changes occurring in the brain. It affects communication between the brain, bladder, and bowel, which leads to a loss of control over the function. Some of the neurological changes that lead to incontinence in people with dementia are due to damage to the frontal cortex, disruption of the micturition pathway, changes in the pontine micturition center, damage to the nerves and changes to the brain’s ability to send and receive signals, which are the reasons for bladder control and thus, lead to incontinence.

Alzheimer's And Incontinence

Alzheimer’s Disease and incontinence are related to people who experience UI and FI. The reason is that the patient experiences neurological changes to the brain, damage to the nervous system, loss of cognitive function, and issues with mobility which are related to urination and bowel movement. This is the reason for incontinence in Alzheimer’s patients.

What Stage Of Alzheimer's Does Incontinence Start?

Incontinence starts during the middle to late stages of Alzheimer’s, which is more common compared to normal cognitive function. Though incontinence is known to start during the middle to late stages of Alzheimer’s, the exact stage in which it starts differs with each person. Stage 6d is when urinary incontinence begins, followed by stage 6e, which is fecal incontinence. During the mid to late stages of Alzheimer’s, cognitive function starts to decline, and the patient has issues with communication, mobility, and operating daily tasks. Thus, it is crucial to learn how to help someone with cognitive impairment.

Common Alzheimer Incontinence Issues

Common Alzheimer’s incontinence issues are urinary incontinence (UI) compared to the general population. Causes of UI in Alzheimer’s disease are neurologic lesions in the nerve centers, damage to the nerve cells, and autonomic neuropathy due to diabetes mellitus and cauda equina syndrome. As for bowel incontinence, it occurs because the patient does not know what is taking place and may not realize they have an urge to go to the bathroom.

Alzheimer's, Bladder And Urinary Control

Here are two types of urinary incontinence in Alzheimer’s patients which are urge incontinence, which is a sudden need to urinate, and stress incontinence, which is when the muscles around the bladder are weak. To manage urinary incontinence in Alzheimer’s patients, methods such as bladder training, using medications such as anticholinergics, and using urinary catheters might be useful to manage incontinence.

Alzheimer's And Loss Of Bowel Control

The reason Alzheimer’s patients struggle with bowel control is because they are unable to recall where the bathroom is, having issues such as urinary tract infections or prostate issues, side effects from the medications, stress, feeling constipated, and having trouble removing clothing.

Symptoms of bowel incontinence are leaky stool or urine, stained bed sheets or underwear, and accidental bowel movements. It is important to speak to a healthcare professional to find out the issues behind it and ways to treat issues such as UTIs to help alleviate symptoms.

Practical Strategies To Managing Incontinence In Dementia Patients

Here are some practical strategies for managing incontinence in dementia patients. Have open communication with dementia patients so that their feelings and concerns are addressed. Ensure a safe space for an open and honest conversation. There should be a sense of trust and understanding that the patient’s needs are being met. Try to use humor to reduce the risk of anxiety and create a routine to reduce the frequency of incontinence. Try to use protective underwear, as there are various types on the market.

Daily Care Techniques For Incontinence

Let us look at some daily care techniques for incontinence:
  • Ensure hygiene, like washing your hands with soap and water.
  • Use a gentle cleanser to clean the private areas.
  • Apply diaper cream to protect the perineal skin and change incontinence products frequently.
Products that may be able to help would be using cotton underwear to help promote airflow and reduce the possibility of moisture buildup. Another product would be using pads or adult diapers to reduce accident risks and manage hygiene.
  • Routines are also important to promote regular toileting and comfort.
  • Establish a regular toilet schedule and encourage patients to sit on the toilet with their feet elevated.
  • Patiently educate the patient to wash after using the toilet and use a gentle cleanser for their intimate areas.
  • Use a potty or chair to help access the toilet easily.
  • Change incontinence products every 2 to 3 hours.
  • Encourage the patient to stretch and take regular breaks to reduce pressure sores.
dementia-couple-working-together

Medications And Therapies For Managing Incontinence In Dementia Patients

There are several medications and therapies to manage incontinence in dementia patients, which could be used alone or in combination with other treatments. Here are some of the most common medications used:
  • Imodium and peptobismol are used to treat diarrhea and constipation.
  • Laxatives help to prevent constipation.
Non-pharmacological treatments can be effective in managing incontinence as well. These treatments range from scheduled bathroom breaks, encouraging the patient to use the bathroom once they wake up, after meals, and before they sleep, bladder training exercises, and pelvic floor exercises to strengthen the muscles. These treatments are appropriate when patients suffer from mild to moderate incontinence, are able to follow a routine or schedule, and have a caregiver or support system to help with toileting.
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Technological Aids For Dementia And Incontinence Management

Let us look at some technological aids for dementia and incontinence management.
  • Bathroom aids such as raised toilet seats and grab bars
  • Toilet seats that can be securely fastened and clear flooring that helps to prevent falling.
  • Using continence care products such as urinary devices and bowel management systems.
  • Smart toilets and bathroom sensors can detect when a patient is in the bathroom.

Smart Continence Monitor And Alert For Dementia Incontinence

Let us look at some smart devices to monitor and alert for dementia awareness, such as
  • Smart watches that can detect falls, monitor vital signs, and provide alerts to caregivers.
  • IoT-based devices that use sensors to track a patient’s location and movement.
  • Smart sensors that can detect falls and determine movement. This gives caregivers alerts in an emergency.
  • Smart cap devices that use facial recognition to assist Alzheimer patients to detect faces and help reduce anxiety.
The effectiveness of using smart technology is that it is able to detect falls, alert caregivers, and detect vital signs in patients. However, the limitations would be issues such as connectivity or sensor malfunctions. It is also important to know that some patients might not like the idea of using devices due to their cognitive disability. Factors such as cost and data security are also important to consider, as they can come across as expensive.

How Can Caregivers Improve The Quality Of Life For Dementia Patients With Incontinence?

Caregivers can improve the quality of life for dementia patients with incontinence by encouraging a balanced diet with exercise, assisting them to use technology to help with their mobility, providing emotional support to provide reassurance, and promoting as much autonomy as possible to patients promoting independence and confidence.

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Frequently Asked Questions About Dementia And Incontinence

What Is Dementia And Incontinence?

The connection between dementia and incontinence is that it affects people with Alzheimer’s and nursing home residents with dementia. It is always linked with the elderly, cognitive decline, and those with physical disabilities increasing. It affects the quality of life for dementia patients, including their caregivers, thus increasing the possibility of social isolation, depression, and anxiety.

Bowel or fecal incontinence affects dementia patients in the middle to later stages. Memory loss impacts the patient’s ability, their bowel movement. As their memory continues to regress, they may forget to use the toilet, struggle to remove their clothing, clean after using the toilet, and even leave the bathroom in a mess. Reduced mobility is another reason for toileting. This is because the patient is unable to move, has an issue in sitting or standing for a long time, and requires assistance to clean themselves after using the washroom.

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